Plicate More Than One Row of Stitches?

4 years ago

i'm 3 months post-op tummy tuck. had very little excess fat or skin but fascia very stretched out, but little muscle separation. after operation, i'm still not very flat in lower abdomen. do you ever plicate more than one row of stitches and how well does that work?

Doctor Answers (14)

I am still bulging after abdominoplasty. How many rows of repair is necessar?

March 7th, 2011

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I usually repair with two rows of continuous non absorbable sutures, but this has noting to do with postoperative bulging. There are patients who have very little subcutaneous fat and all the fat is inside the abdomen, around the bowels. In these patients the key is for them to lose significant amounts of weight before the surgery. You could use ten rows of sutures; it will not make a difference. When I see a patient with this condition I have them loose weight first so I can effectively tighten Their muscles. Then I tell them if they want to keep the results they should not regain the weight.

Muscle Plication with Abdominoplasty / Tummy Tuck

February 21st, 2011

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In most cases, I put 2 to 3 layers of plication regardless of the patient. This is to insure the tightest repair. There are also techniques such as lateral plication that can help with additional tightening and contouring. Without examining you or seeing before and after pictures, it is impossible to give you more specific advice.

The essence of muscle plication with tummy tuck

February 21st, 2011

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Muscle plication with tummy tuck will vary from one individual to another, but the importance is in the strength of the repair. The sutures are permanent in that they will not dissolve and constantly contribute strength to the abdomen. We rely on a double row of sutures, the first to set the abdominal contour and tone correctly, and the second to reinforce and 'set firm' the repair. Muscle plication repairs work well over time, but remember that your tummy will rarely be flatter than when you are flat supine with your stomach relaxed.

Tummy Tuck Pictures

Plication Varies With Each Patient

February 21st, 2011

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Each patient is different, as is the degree of diastasis between the muscles. Some patients need two rows, some three, while others need four. I routinely have four rows of plication sutures, just for added security, from the xiphoid to the pubic bone. I hope this helps.

Muscle Tightening Techniques for Tummy Tucks

February 21st, 2011

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Muscles can be plicated with multiple rows of sutures and in multiple directions. If after tightening in the middle there is still bulging toward the sides more rows of sutures can be used there. Occasionally patients muscle tone is so poor, or they are so heavy inside the abdomen that no matter how many stitches you use it will not be flat.

Muscle Plication for Tummy Tuck

February 20th, 2011

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Depending on the degree of muscle laxity, I will commonly use two rows of plication to reduce the chance of stretching. At three months, you most likely have a component of postoperative swelling. In addition, depending on your intra-abdominal anatomy, it may not be possible to achieve a completely flat abdomen, without compromising your intra-abdominal space. This is something your plastic surgeon can point out in the initial consultation and make appropriate recommendations.

Muscle Plication

I will use two rows in most cases, and a single row if future pregnancy is a possibiity. The individual patient's anatomy also has a lot to do with it.

Swelling below the belly button like may make you appear too full for now, even at 3 months. This often settles over time and your surgeon may want you in a compression garment or recommend lymphatic massage.

Tightening of the Muscle in Tummy Tuck

February 20th, 2011

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The muscle can be plicated centrally with several rows of sutures. I will frequently remove the diastasis and then tighten additionally if that was not enough. I also frequently plicate the lateral muscle fascia if the abdomen is not flat after removing the diastasis. Exceptionally rarely, I have even added mesh when the fascia is quite thin. In some people, no matter what you do, however, you may not be able to get the abdomen perfectly flat. Some people also have a prominent lower abdomen that we cannot change much. Talk to your surgeon about what he/she was and was not able to do.

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